First-Line Treatment of Newly Diagnosed Elderly Patients with Chronic Myeloid Leukemia: Current and Emerging Strategies
First-Line Treatment of Newly Diagnosed Elderly Patients with Chronic Myeloid Leukemia: Current and Emerging Strategies
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新诊断老年慢性粒细胞白血病患者的一线治疗：当前和新兴策略
作者：
G. Gugliotta;F. Castagnetti;M. Apolinari;S. Pirondi;M. Cavo;M. Baccarani;G. Rosti
慢性粒细胞白血病(CML)是一种造血干细胞疾病，根据大多数流行病学登记，确诊时的中位年龄为60-65岁。在酪氨酸激酶抑制剂(TKI)时代之前，高龄被认为是一个不利的预后因素，并被包括在CML的两个最常用的评分系统中，Sokal评分和Euro评分。此外，考虑到观察到的较高毒性，年龄较大通常被认为是异基因干细胞移植使用的限制。在引入TKIs后，年龄在慢性期(CP)患者中失去了大部分对预后的影响，而接受伊马替尼治疗的患者产生的EUTOS评分并未将年龄确定为风险变量。然而，大多数CML患者需要终生治疗；因此，随着患者在接受TKI治疗时年龄增大，老年患者管理的复杂性可能会随着时间的推移而增加。到目前为止，伊马替尼是第一个引入的TKI，以及两个第二代TKI，尼洛替尼和达沙替尼，已在大多数西方国家被批准用于CML的一线治疗。这些药物在有效性、安全性和成本方面各不相同；因此，了解它们的特点对于优化老年CML患者的治疗非常重要。我们回顾了年龄对TKI时代CP CML患者一线治疗的影响，考虑了疾病的流行病学，合并症的作用，并分析了基于人群的研究和临床试验的数据。
Chronic myeloid leukemia (CML) is a disease of the hematopoietic stem cell characterized by a median age at diagnosis of 60–65 years according to most epidemiologic registries. Prior to the tyrosine kinase inhibitor (TKI) era, older age was considered an adverse prognostic factor and was included in two of the most used scoring systems for CML, the Sokal score and the Euro score. Moreover, older age was generally considered a limitation for the use of allogeneic stem-cell transplantation, given the higher toxicity observed. After the introduction of TKIs, age lost much of its prognostic impact in patients in chronic phase (CP), and the EUTOS score, developed in patients treated with imatinib, did not identify age as a risk variable. However, most CML patients require life-long treatment; therefore, as patients age while taking a TKI, the complexity of the management of elderly patients may increase over time. To date, imatinib, the first TKI introduced, and two second-generation TKIs, nilotinib and dasatinib, have been approved in most Western countries for the first-line treatment of CML. These drugs differ in terms of efficacy, safety, and costs; therefore, knowledge of their characteristics is extremely relevant for optimal management of elderly CML patients. We reviewed the impact of age on the first-line treatment of CP CML patients in the TKI era, considering the epidemiology of the disease, the role of comorbidities, and analyzing data from population-based studies and clinical trials.
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影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW
DOI：
10.1056/nejmoa1306494
发表时间：
2013-11-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cortes JE;Kim DW;Pinilla-Ibarz J;le Coutre P;Paquette R;Chuah C;Nicolini FE;Apperley JF;Khoury HJ;Talpaz M;DiPersio J;DeAngelo DJ;Abruzzese E;Rea D;Baccarani M;Müller MC;Gambacorti-Passerini C;Wong S;Lustgarten S;Rivera VM;Clackson T;Turner CD;Haluska FG;Guilhot F;Deininger MW;Hochhaus A;Hughes T;Goldman JM;Shah NP;Kantarjian H;PACE Investigators
通讯作者：
PACE Investigators
影响因子：
20.3
作者：
Kantarjian, Hagop;O'Brien, Susan;Cortes, Jorge
通讯作者：
Cortes, Jorge
DOI：
10.1056/nejmoa1205127
发表时间：
2012-11-29
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cortes JE;Kantarjian H;Shah NP;Bixby D;Mauro MJ;Flinn I;O'Hare T;Hu S;Narasimhan NI;Rivera VM;Clackson T;Turner CD;Haluska FG;Druker BJ;Deininger MW;Talpaz M
通讯作者：
Talpaz M
传播伊马替尼治疗慢性粒细胞白血病的年龄差异。
DOI：
10.1016/j.amjmed.2010.03.018
发表时间：
2010
期刊：
The American journal of medicine
影响因子：
--
作者：
Wiggins,CharlesL;Harlan,LindaC;Nelson,HaroldE;Stevens,JenniferL;Willman,CherylL;Libby,EdwardN;Hromas,RobertA
通讯作者：
Hromas,RobertA